Introducing Evidence-Based Medicine as a Workplace-Based Assessment
Austin Meyer, MD, PhD, MS, MPH, MS, FAAP
2024-09-24
About Me
About my work
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If you are interested in EBM
Overview
Motivating EBM as a Workplace-Based Assessment
Enhancing the Quality of Medical Students’ EBM Presentations
Evaluation and Feedback for EBM Presentations
Motivating EBM was a WBA
WBAs as a Bridge Between Theory and Practice
Traditional classroom-based EBM teaching often fails to translate into clinical skills.
WBAs enable students to apply EBM in real-time, working with actual patients.
Integration of EBM into WBAs provides a continuous learning process, improving knowledge retention and clinical decision-making.
Reference: Coomarasamy & Khan (2004): What is the evidence that postgraduate teaching in evidence based medicine changes anything?
Benefits of Clinical Integration of EBM through WBAs
Increases clinical relevance: Students apply PICO questions directly related to patient care.
Improves retention: WBAs reinforce the application of EBM principles in real clinical scenarios, improving retention compared to standalone methods.
Enhances behavior: Clinically integrated WBAs lead to better behavior change, such as literature review habits and evidence application.
Reference: Coomarasamy & Khan (2004): What is the evidence that postgraduate teaching in evidence based medicine changes anything?
Utilizing Case-Based Learning to Apply EBM
Enhances critical thinking and decision-making skills.
Fosters teamwork and communication among learners.
Case-based learning significantly improves EBM knowledge and application.
Reference: Young T, Rohwer A, Volmink J, Clarke M. What are the effects of teaching evidence-based health care (EBHC)? Overview of systematic reviews.
Essential Components of EBM in WBAs
Problem Formulation: Students develop clinically relevant PICO questions during rounds.
Critical Appraisal: Students assess literature for relevance and validity directly in patient care scenarios.
Application: EBM findings are immediately applied to patient management, bridging theory and practice.
Reference: Kasai et al. (2024): Effect of a workplace-based learning program on clerkship students’ behaviors and attitudes toward evidence-based medicine practice.
Structured Feedback and Reflection in WBAs
Structured Feedback: Feedback on EBM presentations helps students refine their skills and improve their understanding of clinical applicability.
Reflection: Encouraging students to reflect on their EBM processes reinforces continuous learning and helps integrate evidence into future patient care.
Reference: Kasai et al. (2024): Effect of a workplace-based learning program on clerkship students’ behaviors and attitudes toward evidence-based medicine practice.
Students’ Perspective on EBM Teaching in WBAs
Positive Reception: Students generally have a positive perception of learning EBM through practical applications.
Increased Engagement: WBAs make EBM more engaging as students actively formulate clinical questions and apply evidence to real patients.
Improved Skills: Evidence shows improved critical thinking and decision-making skills when students are assessed via WBAs that integrate EBM principles.
Reference: Effectiveness of Teaching Evidence-Based Medicine to Undergraduate Medical Students: A BEME Systematic Review (2024).
Challenges in Implementing EBM as a WBA
Time Constraints: Faculty often struggle to integrate EBM teaching into busy clinical schedules.
Varying Student (and faculty) Preparedness: Differences in prior EBM knowledge can impact the effectiveness.
Sustaining Long-Term Behavior Change: EBM behavior may diminish over time without continuous reinforcement.
Enhancing the Quality of Medical Students’ EBM Presentations
Importance of Asking Answerable Questions
EBM Foundation: The first step in EBM is formulating clear, answerable clinical questions using the PICO framework (Patient, Intervention, Comparison, Outcome).
Types of Questions:
Background: General knowledge about a condition or intervention.
Foreground: Specific knowledge to inform clinical decisions (PICO format).
Reference: How to Practice and Teach EBM: Asking answerable questions is a crucial skill in EBM (Chapter 1).
Teaching Strategies for Asking Better Questions
Role Modeling: Faculty should demonstrate the process of turning clinical uncertainty into answerable questions during rounds.
Interactive Methods: Group activities where students formulate and refine clinical questions with peer and mentor feedback.
Reference: How to Practice and Teach EBM (Chapter 1): Role modeling and interactive teaching enhance question formulation skills.
Acquiring the Best Evidence for EBM
Key Resources: Teach students how to efficiently use preappraised sources (e.g., Cochrane, UpToDate) for quick evidence retrieval.
Search Strategies: Focus on systematic and strategic search techniques (e.g., using Boolean operators, medical subject headings (MeSH)) to find relevant studies.
Understanding Study Hierarchy: Would prefer studies with inherently lower risk of bias.
Reference: How to Practice and Teach EBM (Chapter 2): Effective use of evidence sources is critical to successful EBM presentations.
Appraising Evidence: Levels of Evidence
Teaching the Evidence Search Process
Educational Prescriptions: Assign students clinical questions and guide them through the search process to find answers.
Practical Exercises: Incorporate case-based learning where students are required to locate and appraise evidence for their cases.
Reference: How to Practice and Teach EBM (Chapter 2): Effective teaching involves guiding students through the evidence search process.
Appraising Evidence for EBM Presentations
Critical Appraisal: Teach students how to evaluate the validity, relevance, and applicability of research.
Key Appraisal Criteria:
Study Design: experimental vs. observational studies.
Bias Assessment: How to detect selection bias, performance bias, and publication bias.
Strength of Evidence: Use established tools like GRADE to assess evidence quality.
Reference: How to Practice and Teach EBM (Chapter 3): Critical appraisal is essential for applying evidence effectively.
Self-Assessment: The learner reflects on their performance.
Positive Feedback: Supervisor provides specific, positive remarks on strengths.
Constructive Feedback: Areas for improvement are identified.
Action Plan: The learner outlines steps for improvement.
Benefits:
Promotes reflection and continuous learning.
Ensures feedback is balanced, constructive, and actionable.
Reference: Pendleton, E. J., George, C., Wallis, M., & Kogan, J. (1984). A model of feedback in clinical medical education. Medical Education, 18(6), 343–348.